In part 1 of this blog, we talked a bit about the pelvic floor muscles, what they’re supposed to do and what happens when they’re not functioning properly. I’m sure you’ve been losing sleep in anticipation of Part 2 so I won’t waste any more time! Let’s find out what Pelvic Health Physiotherapy is and what role it can have in dealing with pelvises and pelvic floors that aren’t doing what they’re supposed to do.

What is Pelvic Health Physiotherapy?

Pelvic Health Physiotherapy is the assessment and treatment of dysfunction in the pelvis including dysfunction of the organs, muscles (e.g. the pelvic floor), nerves, and connective tissues in or around the pelvis. While pelvic health is largely concerned with this region of the body, it is by no means the only thing we care about. Many other areas of the body, from head to toe, can influence how well the pelvic muscles work and/or how well the pelvis itself creates stability and contributes to movement.

Here are some conditions that can be effectively treated by pelvic health physiotherapy:

urinary incontinence, fecal incontinence

pelvic organ prolapse

pain with intercourse

chronic constipation

chronic non-bacterial prostatitis

weakness in the pelvic floor muscles and/or abdominal muscles following childbirth or surgery

diastasis recti (separation of the abdominal muscles)

vulvodynia, vestibulodynia

pelvic pain (including coccydenia, sacroiliac joint pain)

pubic symphysis dysfunction

hip, low back, groin, thigh and abdominal pain

If you experience any of the following symptoms or any of the symptoms mentioned above, pelvic health physiotherapy may be able to help:

pressure or heaviness in the vagina/rectum

something visually bulging out the vagina

burning at the vaginal opening or swelling

leaking urine…even a little bit…ever.

trouble voiding your bladder or bowels

trouble making it to the bathroom in time

“doming” down the middle of your belly when you try to do a sit-up or get up from bed.

pain around scar tissue from childbirth or surgery.

pain anywhere in the pelvis

pain with intercourse

not feeling “back to normal” after giving birth or when returning to exercise after birth

persistent low-back, hip and/or groin pain

I’m still wondering, what is Pelvic Health Physiotherapy going to do about this stuff?

Right. A pelvic health physiotherapist can directly assess whether your pelvic floor muscles are tight, weak and/or uncoordinated. Once we understand what is or isn’t functioning well for YOU, we can then choose specific techniques to relax muscles that are tight, strengthen muscles that are weak or re-train those that aren’t coordinated. A pelvic health physiotherapist can also look at how you move during activities or tasks that are troublesome (for example, running) and give you strategies to decrease and eventually eliminate symptoms that arise during these activities. We want to get you back to doing the things you love!

What to expect at an initial visit:

At your first visit, we spend about an hour going over your concerns, medical history and goals for treatment. We listen to your story. We need to hear it. Many people with pelvic issues suffer in silence for a long time. They have often been through numerous medical tests or had several referrals to a variety of healthcare professionals before they even hear about pelvic health physiotherapy. We need to know your journey and how it has impacted your life. Once we’ve heard your story, we do a thorough assessment to determine factors that are contributing to your symptoms and develop a treatment plan best suited to your individual needs and goals. This may include an internal exam.

Internal examination of the pelvic floor muscles vaginally and/or rectally is the best way for us to get information about how the pelvic floor muscles function. Just as a physiotherapist would palpate the muscles around a sore knee, ankle or neck, a pelvic health physiotherapist palpates muscles of the pelvis to locate tender spots and feel which muscles are tight or irritated. Pelvic muscles are just like any other muscles in the body, the only difference is that we can’t assess them very well from the outside and they happen to be located in an area of the body that’s considered very private - an area that we’re not used to having assessed.

Ok. So what does this exam look like?

An internal examination is completed by inserting 1-2 fingers vaginally and/or 1 finger rectally to feel the muscles, nerves and connective tissues within the pelvis. We do not use a speculum. During the exam, we palpate to see how tight or relaxed these muscles are at rest, we look at your muscular strength by getting you to contract the pelvic floor muscles and we get a sense of how coordinated they are (i.e. do they relax or tighten at appropriate times?).

Please note that an internal examination will NEVER be carried out without your consent! If you are not comfortable with having an internal exam completed, there are often things that can be worked on and addressed without having one done so please don’t let this deter you from seeking help! Talk to your physiotherapist and make sure you feel comfortable at all times with the assessment and treatment techniques that are being suggested and implemented. Ask questions if something is unclear and don’t be afraid to speak up if you are uncomfortable at any time.

Treatment is also included at the first visit. Treatment will vary from person to person but always includes education about your condition and tools or strategies you can implement at home for pain relief or improved function. Treatment may also include things like manual therapy, acupuncture, stretches or strengthening exercises such as Kegel’s.

Something else you might not know about pelvic health physiotherapy - you may be covered.

Check your benefits - many private benefits cover physiotherapy. The exact dollar value varies and is dependent on your individual plan. However, if you don’t have private coverage, physiotherapy can also be claimed on your income tax under medical expenses.

Many people ask if you need a physician referral for physiotherapy. While you don’t need one to be assessed and treated by a physiotherapist, it may be required in order to receive reimbursement from your insurance provider. Check your specific insurance plan for further details.

How do I book an appointment??

If you “put up with” any of the symptoms mentioned above, please call Rebirth Wellness Centre at (226) 663-3243 or book online at rebirthwellness.ca. We would love to help you regain confidence, function, strength and control so you can quite avoiding things and get back to doing whatever it is you love doing.